37766 Stab phlebectomy of varicose veins, 1 extremity; more than 20 incisions

Name of the Procedure:

Stab Phlebectomy of Varicose Veins, 1 Extremity; More Than 20 Incisions
Common names: Microphlebectomy, Ambulatory Phlebectomy
Technical term: Varicose Vein Excision

Summary

Stab phlebectomy is a minimally invasive surgical procedure used to remove varicose veins in one extremity. This procedure involves making multiple small incisions to extract the problematic veins.

Purpose

Stab phlebectomy addresses issues related to varicose veins, including pain, swelling, and cosmetic concerns. The goal is to eliminate varicose veins, thereby reducing symptoms and improving the appearance of the affected extremity.

Indications

• Visible, bulging varicose veins
• Symptoms such as aching, swelling, or cramping in the legs
• Recurrent skin ulcers
• Thrombophlebitis (inflammation of veins)
• Other vein-related complications

Preparation

• Follow fasting instructions if advised.
• Adjustments to medications as directed by the physician.
• Pre-procedure ultrasound to map the veins.
• Avoid smoking and certain medications as advised.

Procedure Description

1. Anesthesia: Local anesthesia is applied to numb the area.
2. Incision: A series of small incisions (often more than 20) are made along the vein.
3. Extraction: A specialized hook is used to grasp and remove the vein through the incisions.
4. Closure: Incisions are so small that stitches are usually not required; they are closed with adhesive strips or left open to heal naturally.
5. Bandaging: The leg is bandaged to minimize swelling.

Duration

The procedure typically takes 1 to 2 hours.

Setting

Performed in an outpatient clinic or surgical center.

Personnel

• Vascular surgeon or phlebologist
• Surgical nurse
• Anesthesiologist (if deeper sedation is required)

Risks and Complications

• Common risks: Bruising, swelling, and discomfort in the treated area.
• Rare risks: Infection, nerve damage, deep vein thrombosis (DVT).

Benefits

• Relief from symptoms like pain and swelling.
• Improved appearance of the leg.
• Reduced risk of complications like skin ulcers and thrombophlebitis.
• Benefits are usually noticed within a few weeks.

Recovery

• Wear compression stockings for several days or weeks.
• Avoid strenuous activities for a few days.
• Keep the leg elevated to reduce swelling.
• Follow-up appointments to monitor healing.

Alternatives

• Sclerotherapy: Injection of a solution to collapse the vein.
• Laser treatment: Use of laser energy to close off veins.
• Radiofrequency ablation: Heat applied to destroy the vein.
• Pros and cons vary; sclerotherapy is less invasive but may require multiple sessions, while laser and radiofrequency treatments are less invasive but may be less effective for larger veins.

Patient Experience

• Mild discomfort during the procedure due to local anesthesia.
• Sensation of pulling or tugging as veins are removed.
• Post-procedure pain managed with over-the-counter pain relief.
• Most patients return to normal activities within a few days, with mild bruising and swelling as the only after-effects.